Provider Demographics
NPI:1932780517
Name:SANTOS ALVARADO, WILDELYS
Entity Type:Individual
Prefix:
First Name:WILDELYS
Middle Name:
Last Name:SANTOS ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 SUNSCAPE TER
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8218
Mailing Address - Country:US
Mailing Address - Phone:787-202-4385
Mailing Address - Fax:
Practice Address - Street 1:30 REMINGTON RD STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-9797
Practice Address - Country:US
Practice Address - Phone:407-392-1919
Practice Address - Fax:407-329-1917
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty